Extraction of implantable cardiac devices: the role of transesophageal echocardiography monitoring

Autor: Carmen Gomar, I. Rovira Canudas, R. Navarro, M.J. Arguis, L.E. Mendoza Vasquez, Guillermina Fita, C. Ibañez, M.J. Carretero, P. Matute, J.M. Perdomo, Elena Sandoval
Rok vydání: 2019
Předmět:
Zdroj: Journal of Cardiothoracic and Vascular Anesthesia. 33:S105-S106
ISSN: 1053-0770
DOI: 10.1053/j.jvca.2019.07.054
Popis: Introduction Background: Data for the utility of continuous trans-esophageal echocardiography (TEE) monitoring during trans venous lead extraction remain scarce. Removal of the implanted transvenous lead system can be a significantly complex procedure, facing main complications. Our objective: the retrospective assessment of the TEE in the monitoring during trans venous lead extraction of implantable cardiac devices (pacemaker and implantable cardiac defibrillator). Methods From November 2013 to November 2018 the transvenous lead extraction of 93 leads in 50 patients was reviewed. Lead extraction techniques combined traction and mechanical approach by the same surgeon. Extraction procedures were performed under general anesthesia either total intravenous or inhalation anesthesia. Invasive arterial line blood pressure and continuous TEE monitoring were performed. TEE images of different projections were acquired and stored before and immediately after the extraction of each lead. Results From the 50 patients (mean age 58.9 years, 64% male, 1.86% lead per patient) which had the following indication: lead dysfunction (24%), upgrade (8%), infection (54%), or other (14%). The lead extraction was complete for 69 out of 93 leads (74.19%), partial extraction was for 24 leads out of 93 leads (25.80%). General anesthesia by total intravenous (30%) and inhalation anesthesia (70%). New TEE findings following TEE were observed in 7 of 50 cases (14%). Two cases which had new mild tricuspid regurgitation without the need of re-intervention, new appearance or worsening of tricuspid regurgitation in three cases which needed non-emergency re-intervention and pericardial effusion in two cases. No cases needed rescue surgery. In all other cases, TEE findings did not entail immediate diagnostic or therapeutic measures. Discussion New findings necessitating immediate therapeutic measures occurred zero cases, no mortality, yet all patients with new TEE findings had strict observational control. We suggest TEE monitoring during trans venous lead extraction, as it provides useful real-time information and should be standard of care monitoring during lead extraction, to guide trans operative and postoperative management. TEE presents some non-negligible risks associated with its use and is a costly procedure, such investment, however, may have a high return in terms of increased patient safety.
Databáze: OpenAIRE
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